Jean-François Allilaire

Compulsions, Parkinson's disease, and stimulation

Pathophysiological models suggest that obsessive compulsive disorder (OCD) might be associated with dysfunctions in cortico-striato-pallido-thalamo-cortical neuronal circuits. We implanted subthalamic electrodes to alleviate parkinsonian symptoms in two patients who had Parkinsons disease and a history of severe OCD. Parkinsonian disability improved postoperatively in both patients, and 2 weeks after the procedure, their compulsions had disappeared and obsessive symptoms improved (58% improvement for patient 1 on the Yale-Brown obsessive compulsive scale, 64% for patient 2). The improvements in these two patients suggest that high-frequency stimulation could improve function in the subcortical-limbic circuitry in patients with severe OCD.

Early and late onset bipolar disorders: two different forms of manic-depressive illness?

BACKGROUND Conflicting results in genetic studies of bipolar disorders may be due to the clinical and genetic heterogeneity of the disease. Age at onset of bipolar disorders may be a key indicator for identifying more homogeneous clinical subtypes. We tested whether early onset and late onset bipolar illness represent two different forms of bipolar illness in terms of clinical features, comorbidity and familial risk. METHODS Among a consecutively recruited sample of 210 bipolar patients, we compared early onset (n=58) and late onset (n=39) bipolar patients; the cut-off points were age at onset before 18 years and after 40 years for the two subgroups. The subgroups were compared by independent t tests and a contingency table by raw chi-square test. Morbid risk among first-degree relatives was measured by the survival analysis method. RESULTS The early onset group had the most severe form of bipolar disorder with more psychotic features (P=0.03), more mixed episodes (P=0.01), greater comorbidity with panic disorder (P=0.01) and poorer prophylactic lithium response (P=0.04). First degree relatives of early onset patients also had a higher risk of affective disorders (P=0.0002), and exhibit the more severe phenotype, i.e bipolar disorder. CONCLUSION Our data suggest that early and late onset bipolar disorders differ in clinical expression and familial risk and may therefore be considered to be different subforms of manic-depressive illness.

Qualitative analysis of verbal fluency in depression

The aim of this study was to analyze qualitative aspects of verbal fluency in depression. Phonemic and semantic output was scored for word clustering and switching between clusters in depressed patients and normal control subjects. Depressed patients (n=25) and normal control subjects (n=19) were administered both phonemic and semantic fluency tasks. All patients were also evaluated with executive card sorting tests. Patients with depression produced fewer words on the semantic fluency task than controls and showed normal performance on the phonemic fluency tasks. The deficit on semantic fluency of depressed patients was related to a reduced number of switches with normal cluster sizes. The number of switches in depression was associated with a reduced ability to shift mental set on card sorting tests, suggesting that verbal fluency impairment reflects general executive problems in depression.

The Temperament and Character Inventory-Revised (TCI-R): psychometric characteristics of the French version

Objective:  To explore the psychometric characteristics of a modified version of the Cloningers personality questionnaire, the Temperament and Character Inventory‐Revised (TCI‐R).

Cognitive avoidance of intrusive memories and autobiographical memory: Specificity, autonoetic consciousness, and self-perspective

Autobiographical memory (AM) specificity is impaired in depression and post-traumatic stress disorder. Previous studies emphasised the role of cognitive avoidance of intrusive memories in this impairment. This study aimed to examine the association of cognitive avoidance of intrusive memories with specificity, autonoetic consciousness, and self-perspective. A total of 38 healthy participants were given the revised Impact of Event Scale (IES-R) and an AM task designed to assess positive and negative memories regarding specificity, autonoetic consciousness (remember/know procedure), and self-perspective (field/observer procedure). Taking into account age, verbal IQ, mood, harm avoidance, and executive resources, the IES-R avoidance subscale was negatively correlated with specificity and remember responses for positive memories, and with remember and field responses for negative memories. These findings suggest that cognitive avoidance of intrusive memories is associated with a decrease of the episodic components of AM retrieval.

Problem-solving abilities in unipolar depressed patients: comparison of performance on the modified version of the Wisconsin and the California sorting tests

Problem solving relies on such abilities as decision-making, planning, initiation and hypothesis testing. Although problem-solving deficits have been consistently reported in depression, the specific nature of these deficits is not fully elucidated. In order to assess and isolate cognitive processes underlying problem-solving impairments in depression, depressed patients and normal controls were evaluated with the modified version of the Wisconsin Card Sorting Test (WCST) and the California Card Sorting Test (CCST). The California Card Sorting Test, unlike the modified WCST, provides several different measures of concept generation, concept identification and concept execution. Compared with controls, depressed patients did not show any deficits on all the measures of the modified WCST. In contrast, depressed patients evidenced mild impairment on the CCST with a specific deficit on concept generation but no major problems in concept identification and concept execution. The deficit in concept generation may be rooted in multiple factors such as hypothesis-testing deficits, a loss of cognitive flexibility and a conservative style of response. Since a positive relation between problem-solving deficits and the mean duration of the depressive episode was observed, problem-solving abilities might be predictive of poorer outcome in patients with unipolar affective disorders.

Mid-morning Tryptophan Depletion Delays REM Sleep Onset in Healthy Subjects ☆

Because serotonin is involved in the diachronic regulation of sleep, we tested the effect of a midmorning rapid deficiency in the serotonin precursor tryptophan on the next nights sleep. After a 48-h low-protein diet, 17 healthy volunteers received either a tryptophan-free mixture of amino acids or a placebo at 10:30 A.M., in a randomized double-blind cross-over design, resulting in a 77% decrease and 41% decrease of serum tryptophan at 3:30 P.M. and 9:30 P.M., respectively. Urinary sulfatoxy-melatonin excretion and mood were unaffected by the rapid tryptophan depletion (RTD), but rapid eye movement (REM) sleep latency increased by 21 min (from 91.5 ± 4.5 min to 112.2 ± 6.9 min), sleep fragmentation 58%, and REM density of the first REM sleep period doubled. The results show that midmorning RTD delays REM sleep latency during following night-time sleep, whereas evening RTD shortens REM sleep latency in previous studies, and suggest that the serotonin control of REM sleep latency is upregulated.

Évaluation dimensionnelle des émotions en psychiatrie : validation du questionnaire Émotionnalité positive et négative à 31 items (EPN-31)

Resume Cet article presente les resultats d’une premiere etude de validation du questionnaire Emotionnalite positive et negative (EPN-31) dans une population francaise de patients psychiatriques. Il s’agit d’une echelle d’analyse emotionnelle adaptee par Rolland sur la base des travaux de Diener et du modele « tripartite » des emotions de Watson et Clark. Trois scores principaux sont fournis par ce questionnaire : les emotions positives, les emotions negatives et les emotions de surprise. Six sous-scores peuvent egalement etre calcules. Un groupe de 400 patients psychiatriques a rempli l’EPN-31 et a ete evalue par ailleurs a l’aide de l’echelle HAD (Hospital Anxiety and Depression scale). Une analyse en composantes principales (ACP) a ete effectuee, de meme que des analyses de consistance interne et de validation concourante. L’ACP identifie une structure a trois facteurs correspondant, apres rotation orthogonale Varimax, aux emotions negatives (F1), aux emotions positives (F2) et aux emotions de surprise (F3). Les coefficients de consistance interne varient entre 0,80 et 0,95 pour les trois scores principaux, et entre 0,72 et 0,90 pour les six sous-scores. Le score d’emotions positives est correle negativement a la severite des symptomes depressifs, et le score d’emotions negatives est correle positivement a la severite des symptomes anxieux et depressifs. Le score de surprise parait moins robuste. En conclusion, cette premiere etude de l’EPN-31 confirme la validite et l’interet de cet instrument de mesure des emotions en psychiatrie.

Mémoire autobiographique épisodique et dépression

(1) Unite CNRS 7593, Groupe Hospitalier Pitie-Salpetriere, 47, boulevard de l’Hopital, 75013 Paris.(2) Unite INSERM E 0218, Universite de Caen.(3) Institut de psychologie, EPHE, CNRS UMR 8581, Universite Paris V.(4) Service de Psychiatrie d’Adultes, Groupe Hospitalier Pitie-Salpetriere, Paris.Travail recu le 2 mars 2005 et accepte le 21 mars 2005.

Pseudo-démence conversive et état de stress post-traumatique

Resume Les etats de stress post-traumatique (ESPT) sont souvent associes a d’autres troubles psychiatriques, mais la comorbidite avec les troubles somatoformes est peu etudiee. Le cas decrit dans cet article concerne un patient souffrant d’un ESPT declenche par une agression sexuelle vecue a l’âge de 8 ans. Le deroulement de son histoire est neanmoins tres particulier puisque l’agression a eu lieu plus de trente ans avant l’apparition des troubles. Pendant la plus grande partie de sa vie, entre 13 et 43 ans, le patient avait completement occulte l’evenement traumatique. Puis, pour des raisons inconnues, il developpa un syndrome conversif pseudo-neurologique mimant un etat dementiel inquietant, qui persista plus d’un an. La disparition des symptomes neurologiques et la rememoration du traumatisme furent brutales, apres que le patient ait vu, au cinema, un film relatant l’histoire d’un homme victime d’une agression sexuelle. Apparurent alors les symptomes typiques d’un ESPT, puis d’un etat depressif severe complique d’une tentative de suicide par pendaison. Les liens entre ESPT et conversion devraient faire l’objet d’etudes plus approfondies, d’un point de vueepidemiologique, clinique et de neuro-anatomie fonctionnelle.